EP4062179A1

EP4062179A1 - Fluorimetric analytical method for the determination of creatinine in clinically significant biological samples and a fluorimetric reagent for use in this method

Info

Publication number: EP4062179A1
Application number: EP20833981.2A
Authority: EP
Inventors: Izabela LEWINSKA; Michal Michalec; Robert Koncki; Lukasz TYMECKI
Original assignee: Uniwersytet Warszawski
Current assignee: Uniwersytet Warszawski
Priority date: 2019-10-30
Filing date: 2020-10-30
Publication date: 2022-09-28
Also published as: WO2021086209A1; PL431660A1

Abstract

A fluorimetric analytical method for the determination of creatinine in clinically significant biological samples, in which creatinine is reacted with 3,5-dinitrobenzoic acid in a strongly alkaline aqueous-organic medium to form a fluorophore product is characterized in that a clinically significant biological sample is mixed directly with a multi-component fluorimetric reagent containing 3,5-dinitrobenzoate anions, an organic solvent, water, a base maintaining alkalinity of the reagent above pH = 12, and additionally hydrogen peroxide, whereas detection and/or quantification of the obtained product of creatinine reaction with 3,5-dinitrobenzoate anions is carried out using the fluorimetric method, by taking a measurement of radiation having a wavelength of 450-500 nm, preferably 480 nm, emitted under the influence of an excitation beam of radiation of a wavelength of 380-420 nm, preferably 405 nm, at a constant incubation time after the start of the reaction and determining creatinine concentration on the basis of separately prepared calibration curve that links creatinine concentration in the biological sample with the fluorimetric response characteristic for the given wavelength and incubation time. A multi-component fluorimetric reagent for use in the analytical fluorimetric method for determination of creatinine in clinically significant biological samples, being alkaline and containing 3,5-dinitrobenzoate anions in an aqueous-organic environment is characterized in that it additionally contains hydrogen peroxide, and after direct mixing with a clinically significant biological sample containing creatinine, selectively produces a fluorophore in the reaction between creatinine and a 3,5-dinitrobenzoate anion, which fluorophore under the influence of an excitation beam of radiation of 380-420 nm wavelength, preferably of 405 nm wavelength, emits radiation of 450-500 nm wavelength, preferably of 480 nm wavelength. The fluorimetric method according to the invention allows to accurately and precisely determine the concentration of creatinine in biological samples. The results obtained with the method according to the invention are consistent with the results obtained in the Clinical Laboratory, which routinely uses the enzymatic method. It is a single point method that requires relatively short incubation times (200-630 s), which allows to avoid the inconvenience of enzymatic methods. The creatinine determination range is 0.5-1000 μmol-L^-1, for incubation times of 20-3600 s, preferably 3-750 μmol-L^-1 for 300 s. The method according to the invention allows the measurement of creatinine in blood serum samples, urine or dialysate after adequate dilution. The speed of measurements and simplicity of measurements, as well as the use of non-toxic components of the fluorimetric reagent, make it possible to create measurement systems ready for use at any time and place, in accordance with the point of care testing concept. The unit measurement price is competitive with other routinely used methods of creatinine determination in biological samples.

Description

Fluorimetric analytical method for the determination of creatinine in clinically significant biological samples and a fluorimetric reagent for use in this method

The present invention relates to a fluorometric method for the determination of creatinine in clinically significant samples and a reagent for use in the fluorimetric method for the determination of creatinine in clinically significant samples.

Creatinine is one of the metabolites of nitrogen compounds, present in all body fluids. It has no biological function and is removed from the bloodstream in kidneys (by glomerular filtration) and then excreted in urine from the body. Serum creatinine level is a marker of kidney filtration function and therefore a marker of a number of diseases.

In clinical laboratories, the accuracy and speed of a single creatinine determination in a clinically significant sample play an important role, and creatinine itself, beside glucose, is one of the most frequently determined metabolites. Creatinine level is routinely measured in serum and urine samples, mainly to assess kidney function, but also in diagnostics of diseases resulting in muscle loss, as an indication of urine dilution, and to predict the risk of acute renal failure.

There are many known methods of creatinine determination in biological samples. They cover the entire spectrum of instrumental techniques available today: from spectroscopic techniques (photometry, fluorimetry), through electrochemical techniques, including current and potentiometric methods, to separation techniques: chromatography and electromigration.

In analytical practice, the Jaffe method developed in 1886 [M. Jaffe, Z. Physiol. Chem. 10 (1886) 391-400] is recommended for routine creatinine determination in clinically significant samples, despite its numerous disadvantages, including-Low selectivity for among others glucose and proteins. In the case of determinations in more advanced investigations, definitely more selective enzymatic methods are used although they are also more expensive.

The Jaffe method for the determination of creatinine in biological samples is based on the reaction between creatinine and picric acid (2,4,6-trinitrophenol) in an alkaline environment. The reaction product is an orange creatinine-picric acid complex/adduct, which can be determined spectrophotometrically in the wavelength range 470-550 nm. One of the postulated course of the reaction may be presented in the following reaction scheme:

The Jaffe reaction was adapted to the colorimetric determination of creatinine in urine in 1904 [O. Folin and J. L. Morris, J. Biol. Chem. 17 (1914) 469-473] and in deproteinized blood in 1919 [O. Folin and H. Wu, J. Biol. Chem. 38 (1919) 81-110]. Typical reagent concentrations and analytical parameters for the Jaffe protocol are shown in Table 1. Table 1. Typical reagent concentrations and analytical parameters in the Jaffe protocol, [elaboration based on the technical manual for the Roche Cobas 5000 apparatus, CREJ2 assay protocol]

* Quantification limit determined according to the requirements of EP17-A CLSI (Clinical and Laboratory Standards Institute) as the 95th percentile of values from n> 60 blank measurements in several independent series.

** The lower detection limit is the lowest measurable concentration of the analyte that can be distinguished from zero (3 standard deviations from the lowest standard, repeatability n> 21).

One of the most significant drawbacks and disadvantages of the Jaffe method is the fact that the course of the reaction is highly temperature dependent, and therefore the slope of the orange complex calibration curve is also temperature dependent. In the wavelength range of 475-520 nm, the absorbance of the creatinine-picric acid complex/adduct increases with increasing temperature, with the degree of increase in absorbance being different for different wavelengths at which it is measured. For this reason, an increase in temperature by 1°C can cause an error in the measured creatinine concentration by up to 0.7 μmol.L^-1 if the measurement is made at 490 nm, while when the absorbance is measured at wavelengths longer than 500 nm, an error caused by temperature fluctuations is several times smaller. In addition, picric acid used in the Jaffe method, as a dry solid reagent, is an explosive substance and toxic to humans in case of contact with skin, inhalation and ingestion. Therefore, the preparation of the reagent must be carried out by trained personel.

The main disadvantage of the Jaffe method, however, is its low selectivity. Creatinine is not the only compound that forms a red complex when reacted with picric acid, and a similar effect is also observed in the presence of acetone or glucose. The list of interferents of the Jaffe method includes more and more substances, including: proteins, bilirubin, glucose, ascorbic acid, acetoacetates and antibiotics belonging to the cephalosporin group, and the total number of known interferents already reaches over 200. Some of them increase and other reduce the signal, while in comparison with more reliable methods, the Jaffe method increases the obtained results by about 27 μmol.L^-1, at average [B. Wuyts et al., Clin. Chem. 49 (2003) 1011-1014].

Many attempts have been made to increase selectivity of the Jaffe method, but the only method routinely used in clinical analysis is a discriminant - sometimes called kinetic or two-point, measurement [D. L. Fabiny, Clin. Chem. 17 (1971) 696-700]. As the analytical signal, instead of the absorbance, the difference in absorbance measured at 80^th and 20^th second of the reaction at a wavelength of 520 nm is used. In this way, the influence of compounds, for example bilirubin, that react with picric acid with kinetics different to that of creatinine, is eliminated. Another advantage of using the two-point measurement is elimination of the influence of the sample color on the obtained result, because both blood serum and urine absorb radiation in the analytical range of the Jaffe method. The presented modification of the Jaffe method does not release it from all the known drawbacks. First of all, the influence of proteins on the measured creatinine concentration is not eliminated. Moreover, the double absorbance measurement creates a difficulty in the measurement methodology and causes the propagation of measurement uncertainty.

As an alternative to the attempts to modify the Jaffe method in order to improve its selectivity, it was proposed to replace picric acid with another nitro derivative of benzene, namely 3,5-dinitrobenzoic acid (DNBA) [A. Bollinger, Med. J. Aust. 2 (1936) 818-821; S. R. Benedict and J. A. Bahre, W. Langley and M. Evans, J. Biol. Chem. 114 (1936) 515-532; J. Biol. Chem. 115 (1936) 333-341]. The reaction is analogous to the reaction with picric acid according to the scheme:

Due to the introduced change of the reagent, the method is more selective for creatinine than the classic Jaffe method, because compounds such as glucose, fructose, creatine or guanidine do not affect the measurement [J. Carr et al., Anal. Chem. 25 (1953) 1859-1863]. The kinetics of the creatinine reaction with 3,5-dinitrobenzoic acid is largely dependent on the concentration of sodium hydroxide: at low concentrations the product forms slowly but is stable over time, while at higher concentrations the reaction kinetics are faster but the product decomposes. The results with the best reliability are obtained with a 3,5-dinitrobenzoic acid solution in a concentration of 0.25 mmol L^-1 and a sodium base solution of the same concentration, whereas the absorbance reading at 500 nm wavelength is made 60 minutes after mixing the reagents [J. Carr et al., Anal. Chem. 25 (1953) 1859-1863].

There are also reports on methods based on fluorimetric detection. The basis of the described fluorescent kidney function test is the creatinine reaction with an alkali metal salt of 3,5-dinitrobenzoic acid [K. G. Blass, Clin. Biochem. 28 (1995) 107-111; K. G. Blass, US 5,527,708 (1996)].

There is known a fluorimetric method of creatinine detection that employs a palladium (II) complex of naphthalimide derivative, which complex does not show fluorescence in a buffer of pH 7.2. After addition of creatinine solution, the palladium ion is removed from the complex and is bound by the analyte molecule. The ligand itself (naphthalimide derivative), devoid of the palladium ion, fluoresces with an emission maximum at a wavelength of 530 nm, when excited at a wavelength of 440 nm. The dependence of the creatinine concentration on the fluorescence intensity can be approximated by the square function within the range of creatinine concentrations ranging from 0 to 300 μmol.L^-1 [S. Pal et al., Chem. Commun. 52 (2016) 13706-13709]. The developed protocol shows a correlation with the results obtained by the Jaffe method.

There is known a fluorimetric method of creatinine determination involving its reaction with a chalcone derivative [S. Ellairaja et al., ACS Sensors. 3 (2018) 2463-2466]. This compound is characterized by a quantum yield of 0.85 at pH of 10 and, when excited by radiation of 407 nm wavelength, it has two emission maxima: one at a wavelength of 473 nm and the other at 587 nm, and the presence of creatinine shifts the emission maximum of the compound towards shorter waves. Other metabolites present in biological samples, such as urea, bilirubin, amino acids and proteins, and metal ions do not cause such a shift. The method is selective for creatinine, but is characterized by low precision (RSD 7%) [S. Ellairaja et al., ACS Sensors. 3 (2018) 2463-2466].

In literature there are reports on other systems for the fluorimetric determination of creatinine concentration. For example, there is known a method based on increasing the emission of rhodamine complex with gold(lll) ions in the presence of creatinine [S. Ellairaja et al., ChemistrySelect 2 (2017) 1025-1031], and a method employing an interaction of creatinine with quantum dots coated with thioglycolic acid [N. Tajarrod et al., Anal. Methods 8 (2016) 5911-5920].

An alternative type of creatinine determinations in body fluids are enzymatic methods. This group of analytical methods provides much greater selectivity in effect of the substrate specificity of the enzyme used. In such methods, the analyte is converted by one or more enzymatic reactions into a product that can be easily determined by spectroscopic or electrochemical techniques.

The only method of enzymatic creatinine determination, which apart from the Jaffe method, is routinely used in clinical laboratories, is the colorimetric method for the determination of hydrogen peroxide resulting from a cascade of enzymatic reactions: creatinine creatine creatine urea + sarcosine sarcosine + O2 glycine + H₂O₂

The hydrogen peroxide is converted into the absorbing compound by another enzymatic reaction, catalyzed by peroxidase (EC 1.11.1.7) in the presence of an acceptor. The absorbance of the reaction product is measured at 510 nm. The linear range of the method is up to 2210 μmol.L^-1 creatinine and the incubation time is 30 minutes. The method is characterized by high selectivity, however, in order to eliminate interference caused by ascorbic acid, the addition of ascorbate oxidase is necessary, while the addition of potassium ferrocyanide reduces the reduction of the signal caused by the presence of bilirubin [P. Fossati et al., Clin. Chem. 29 (1983) 1494-1496]

Currently, a modified version of the above method is used in routine clinical analysis. 3,5- Dichloro-2-hydroxybenzenesulfonic acid is replaced by a more effective hydrogen peroxide scavenger: 2,4,6-triiodo-3-hydroxybenzoic acid. The product of the enzymatic reaction is determined colorimetrically at a wavelength of 552 nm. The method has a creatinine detection limit of 5 μmol.L^-1 while its linear range is 2700 μmol.L^-1. The precision and repeatability, expressed as relative standard deviation, are less than 3%. The selectivity of the colorimetric enzyme method is much better than that of the Jaffe method. No influence of bilirubin (up to 324 μmol.L^-1), hemoglobin (up to 497 μmol.L^-1), ascorbic acid (up to 1700 μmol.L^-1), creatine (up to 3.05 mmol.L^-1 ) and most drugs for the results obtained has been noticed.

Isotope Dilution Mass Spectrometry (IDMS) is considered a completely selective (i.e. specific) method for determination of creatinine. The measurement procedure consists in enriching the sample with ¹³C-labeled creatinine. The creatine is then separated from the sample using a weak acid ion exchange resin column and the creatinine is converted to N-(4,6-dimethyl-2-pyrimidinyl)- N-methylglycine ethyl ester. The next step is the analysis by mass spectrometry of the intensity ratio of peaks related to the creatinine derivative being not enriched and the isotopically enriched creatinine derivative [M. J. Welch et al,. Anal. Chem. 58 (1986) 1681-1685]. The method is characterized by a very high precision and selectivity and is currently considered the reference method for determining creatinine. Unfortunately, the measurement of creatinine concentration by this method is very laborious and takes more than 24 hours (including sample preparation), and that is why it is not used routinely.

Another available method for determining creatinine is capillary electrophoresis, employing differences in the rate of compounds migration in an electric field.

It is also known to use high-performance liquid chromatography to determine the concentration of creatinine in biological samples. Creatinine is separated from the other sample components on a Nucleosil 120-3 C18 packed column. A mixture of water and acetonitrile (5% v/v acetonitrile) with the addition of sodium salt of octane sulfonic acid is used as an eluent. The latter compound acts as a reagent for the formation of ion pairs, being recommended due to the fact that that creatinine is a cation under the conditions of the measurement. Spectrophotometric detection is made at a wavelength of 236 or 215 nm. In such a system, the creatinine retention time is 7.26 minutes. The limit of creatinine determination under optimized conditions is 82 pmol.L^-1. This method has been proven effective in urine and blood serum samples. None of the other compounds present in such samples is eluted together with creatinine [D. Tsikas et a!., Clin. Chem. 50 (2004) 201-203).

In view of the absence in the prior art of an efficient, reliable and selective method of creatinine determination, that would involve additionally low analysis costs, it is the aim of the present invention to provide a new analytical method based to the maximum extent on known reagents, to be carried out using an optical detection and equipment commonly used in analytical laboratories, especially in clinical analytical laboratories.

This object is achieved in accordance with the invention, comprising a method for determining creatinine in clinically significant samples and a reagent to be used in the method.

Summary of the invention

A fluorimetric analytical method for the determination of creatinine in clinically significant biological samples, in which creatinine is reacted with 3,5-dinitrobenzoic acid in a strongly alkaline aqueous-organic medium to form a fluorophore product, is characterized in that a clinically significant biological sample is mixed directly with a multi-component fluorimetric reagent containing 3,5-dinitrobenzoate anions, an organic solvent, water, a base maintaining alkalinity of the reagent above pH=12, and additionally hydrogen peroxide, whereas detection and/or quantification of the obtained product of creatinine reaction with 3,5-dinitrobenzoate anions is carried out using the fluorimetric method, by taking a measurement of radiation having a wavelength of 450-500 nm, preferably 480 nm, emitted under the influence of an excitation beam of radiation of a wavelength of 380-420 nm, preferably 405 nm, at a constant incubation time after the start of the reaction and determining creatinine concentration on the basis of separately prepared calibration curve that links creatinine concentration in the biological sample with the fluorimetric response characteristic for the given wavelength and incubation time.

According to the invention, as a component containing 3,5-dinitrobenzoate anions, a solution of 3,5-dinitrobenzoic acid, a 3,5-dinitrobenzoate salt, preferably sodium 3.5-dinitrobenzoate or 3,5-dinirobenzoic acid ester, preferably methyl 3,5-dinitrobenzoate is used, the solution comprising an organic solvent, a mixture of organic solvents, water, or a mixture thereof. A solvent which is highly miscible with water, preferably a monohydric alcohol or a polyhydric alcohol is used as the organic solvent. Methanol, ethanol, propanol or butanol is used as the monohydric alcohol, and 1,4-butanediol, 1,2-propanediol or ethylene glycol is used as the polyhydric alcohol, 1,4-butanediol being most preferable. A solution having a concentration greater than 0.05 mol.L^-1 is used as the base-containing component, which solution comprises water, an organic solvent or a mixture of organic solvents, or a mixture thereof. As a base, a metal hydroxide, ammonium hydroxide or an organic base that does not significantly interfere with the fluorescence of the reaction product of creatinine with a 3,5-dinitrobenzoate anion, preferably an alkali metal hydroxide (LiOH, NaOH, KOH, RbOH, CsOH), ammonium hydroxide, tetramethylammonium hydroxide, tetraethylammonium hydroxide, tetrabutylammonium hydroxide, or mixtures thereof, most preferably LiOH, NaOH or KOH, is used. As a component containing hydrogen peroxide, an aqueous or aqueous-organic hydrogen peroxide solution is used.

According to the invention, the fluorimetric reagent is made of components including

3.5-dinitrobenzoic acid, 1,4-butanediol, water, NaOH and hydrogen peroxide, the components being mixed in any order and combination prior to adding the biological sample of clinical significance. At first, stable component solutions are prepared, preferably a solution containing 3,5-dinitrobenzoic acid, 1,4-butanediol, water and hydrogen peroxide, and a component solution containing water and NaOH, which component solutions are mixed immediately before adding the biological sample of clinical significance.

According to the invention, for samples containing creatinine in a concentration lower than or equal to 750 μmol.L^-1, the reagent is used in which:

- the concentration of 3,5-dinitrobenzoate ions ranges from 0.05 mmol.L-1 up to saturation, preferably 12.5 mmol.L^-1,

- the base concentration is 0.05-2 mol.L^-1, preferably 1 mol.L^-1,

- the concentration of hydrogen peroxide is 1.45-145 mmol.L^-1, preferably 29 mmol.L^-1,

- the mutual ratio of solvents ranges from completely aqueous to aqueous-organic containing 0.3% water, and the optimal ratio of organic solvent to water in the water-organic mixture is from 0.8:1.

Samples containing creatinine in concentration greater than 750 μmol.L^-1 are diluted to a concentration lower than or equal to 750 μmol.L^-1

According to the invention, the volume ratio of the fluorimetric reagent to the clinically significant biological sample is from 1:1 to 299:1, preferably 14:1. The measurement of the fluorescence intensity is performed in the range of the observed linear dependence of the fluorescence intensity on the creatinine concentration, i.e. after the time of 20-3600 s, preferably 300 s. The creatinine determination range is within the range of 0.5-1000 μmol.L^-1 for the incubation (reaction) time of 20-3600 s, preferably 3-750 μmol.L^-1 for 300 s.

The method according to the invention is selective for creatinine in the presence of sugars, proteins and bilirubin. A clinically significant biological sample is a blood serum at a 2-10-fold dilution, preferably at 5-fold dilution; a urine at a 10-400-fold dilution, preferably at 50-fold dilution; or a dialysate at a 1-5-fold dilution, preferably at 2-fold dilution. A multi-component fluorimetric reagent for use in the analytical fluorimetric method for determination of creatinine in clinically significant biological samples, being alkaline and containing 3,5-dinitrobenzoate anions in an aqueous-organic environment, characterized in that it additionally contains hydrogen peroxide, and after direct mixing with a clinically significant biological sample containing creatinine, selectively produces a fluorophore in the reaction between creatinine and a 3,5-dinitrobenzoate anion, which fluorophore under the influence of an excitation beam of radiation of 380-420 nm wavelength, preferably of 405 nm wavelength, emits radiation of 450-500 nm wavelength, preferably of 480 nm wavelength.

According to the invention, the reagent contains 3,5-dinitrobenzoate ions at a concentration of from 0.05 mmol.L^-1 up to saturation, preferably 12.5 mmol.L^-1; the base at a concentration of 0.05-2 mol.L^-1, preferably 1 mol.L^-1; hydrogen peroxide at a concentration of 1.45-145 mmol.L^-1, preferably 29 mmol.L^-1; and the mutual ratio of the solvents ranges from completely organic to fully aqueous, and the optimal ratio of organic solvent to water in the aqueous-organic mixture is from 0.8:1. According to the invention, the reagent comprises 3,5-dinitrobenzoic acid, 1,4-butanediol, water, NaOH and hydrogen peroxide. After its preparation, it is stable at room temperature for over 100 hours. The reagent can be used for the selective determination of creatinine at concentrations ranging from 3-750 μmol.L^-1 in the presence of glucose, proteins and bilirubin, for an incubation time of 20-3600 s, preferably 300 s.

When using the solution according to the invention, it is possible to accurately and precisely determine the concentration of creatinine in biological samples. The results obtained with the method according to the invention are consistent with the results obtained in the Clinical Laboratory, which routinely uses the enzymatic method, which requires the use of as many as four enzymes and a number of other reagents. Enzyme preparations are relatively expensive and must be stored in refrigerators at low temperatures, and in solutions are often quite unstable. In addition, a decisive difficulty of polyenzymatic methods is to find the optimal reaction conditions, especially the pH of the solution and the temperature at which all enzymes work satisfactorily. Overcoming these drawbacks by using the simple, one-point method according to the invention is very attractive, that being its most important advantage over the prior art methods for creatinine determination.

It is also an advantage of the present invention that the measurement in the disclosed method is a single point one and the reagents are non-toxic, which allows for the development of mobile measurement systems. Using the method according to the invention, it is possible to create systems ready to use at any time and place, in accordance with the concept of the point of care testing, i.e. carrying out analytical tests directly at the place of patient care, for example at the bedside in the hospital, in ambulances or in the offices of primary contact (GP) doctors, by personnel not being trained in clinical analytics.

The possibility of abandoning the two-point measurement in the practice of analytical laboratories is a great help in routine determinations, and most importantly, it reduces the measurement uncertainty. In the case of the two-point measurement, the analytical signal is a difference of two values, both of which are subject to measurement uncertainty. In the simplest terms, the error of the difference between the two values will be the square root of the sum of the squared errors of the two measurements, therefore the obtained error value is greater than that of the single-point measurement. The invention will now be described in detail by way of example with reference to the accompanying drawing. The values in the graph correspond to the final concentrations in the reagent.

Fig. 1 shows the excitation and emission spectra of the creatinine - 3,5-dinitrobenzoic acid (DNBA) reaction product dissolved in 1,4-butanediol (BTD). Creatinine (250 μmol-L^-1), DNBA (12.5 mmol.L^-1), NaOH (1 mol.L^-1), H₂O₂ (29 mmol.L^-1), V_BTD/V_H2O = 0.8:1.

Fig. 2 shows a comparison of the dependence of the fluorescence intensity of the creatinine- DNBA reaction product on time for the process carried out without the addition of H₂O₂ according to the K.G. Blass protocol [Clin. Biochem. 28 (1995) 107-111] and for the process with the addition of 29 mmol.L^-1 H₂O₂ according to the present invention. Excitation wavelength λ_ex = 405 nm, emission wavelength λ_em = 480 nm. H₂O₂ concentration in water: C°H₂O₂ = 580 mmol.L^-1. Component concentrations in the reagent: DNBA (12.5 mmol.L^-1), NaOH (1 mol.L^-1), 1,4-butanediol to water volume ratio: V_BTD/V_H2O = 0.8:1. Creatinine concentration in the standard (250 μmol.L^-1). The ratio of the volume of the fluorimetric reagent to the sample volume: V_REAGENT/V_SAMPLE = 14:1.

Fig. 3 shows the dependence of the fluorescence intensity of the creatinine-DNBA reaction product on time for the different solvents used to dissolve DNBA. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (12.5 mmol.L^-1), NaOH (1 mol.L^-1), H₂O₂ (29 mmol.L^-1), V_SOLVENT/V_H2O = 0.8:1. Creatinine standard solution (250 μmol.L^-1), V_REAGENT/V_SAMPLE = 14:1. n = 3.

Fig. 4 shows the dependence of the fluorescence intensity of the creatinine-DNBA reaction product on time for various concentrations of H₂O₂ in the reagent in the range of 0-145 mmol.L^-1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (13.5 mmol.L^-1), NaOH (1 mol.L^-1), V_SOLVENT/ VH₂O = 0.8:1. Creatinine standard solution (250 μmol.L^-1). V_REAGENT/V_SAMPLE = 14:1.

Fig. 5 shows the dependence of the fluorescence intensity of the creatinine-DNBA reaction product for different volume ratios of BTD to aqueous solution of H₂O₂ in a fluorimetric reagent ranging from 4:1 to 49:1, and also in the absence of H₂O₂. The range of changes in the concentration of H₂O₂ in the fluorimetric reagent is 0-58 mmol.L^-1. The range of V_BTD/V_H2O changes in the fluorimetric reagent ranges from 1:1 to 0.67:1. λ_ex = 405 nm, λ_em = 480 nm. C°H₂O₂ = 580 mmol.L^-1. Reagent: DNBA (13.5 mmol.L^-1), NaOH (1 mol.L^-1). Creatinine standard solution (250 μmol.L^-1). V_REAGENT/V_SAMPLE = 14:1.

Fig. 6 shows the relationship of the fluorescence intensity of the creatinine-DNBA reaction product over time for different concentrations of DNBA in the fluorimetric reagent from zero to saturation. λ_ex = 405 nm, λ_em = 480 nm. Reagent: NaOH (1 mol.L^-1), H₂O₂ (29 mmol.L^-1), V_BTD/V_H2O = 0.8:1. Creatinine standard solution (250 μmol.L^-1). V_REAGENT/V_SAMPLE = 14:1

Fig. 7 shows the dependence of the fluorescence intensity of the creatinine-DNBA reaction product on time for various NaOH concentrations in the range of 0-2 mol.L^-1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (12.5 mmol.L^-1), H₂O₂ (29 mmol.L^-1). V_BTD/V_H2O = 0.8:1. Creatinine standard solution (250 μmol.L^-1). V_REAGENT/V_SAMPLE = 14:1.

Fig. 8 shows the calibration characteristics of the method for determining creatinine in an aqueous-organic environment according to the invention for a creatinine concentration in the range of 0-1000 μmol.L^-1, for reaction times: 200 s, 300 s and 630 s. V_REAGENT/V_SAMPLE = 14:1. The number of repetitions of the measurement: n = 3. Fig. 9 shows the dependence of the fluorescence intensity of the creatinine-DNBA reaction product on time for the albumin concentration in the range of 0-40 g-L^-1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (12.5 mmol.L^-1), H₂O₂ (29 mmol.L^-1). V_BTD/V_H2O = 0.8:1. Creatinine standard solution (250 μmol-L^-1). = 14:1. n = 3.

Fig. 10 shows the calibration characteristics of the method of creatinine determination according to the invention for the concentration of creatinine in the range of 0-300 μmol-L^-1, for pure solutions and with the addition of albumin at a concentration of 40 g-L^-1, for the measurement time: 200 s. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (12.5 mmol-L^-1), H₂O₂ (29 mmol-L^-1). = 0.8:1. Creatinine standard solution (250 μmol-L^-1). = 14:1. n = 3.

Fig. 11 shows the relationship of the fluorescence intensity of the creatinine-DNBA reaction product over time in the water environment for various concentrations of H₂O₂ in the fluorimetric reagent in the range of 0-145 mmol-L^-1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (13.5 mmol.L^-1), NaOH (0.8 mol.L^-1). Creatinine standard solution (250 μmol-L^-1).

Fig. 12 shows the relationship of the fluorescence intensity of the creatinine-DNBA reaction product over time in the water environment for various concentrations of DNBA in the fluorimetric reagent in the range of 0-50 mmol.L^-1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: NaOH (0.8 mol.L^-1), H₂O₂ (29 mmol.L^-1). Creatinine standard solution (250 μmol-L^-1).

Fig. 13 shows the dependence of the fluorescence intensity of the creatinine-DNBA reaction product on time for various concentrations of NaOH in the range of 0-2 mol.L^-1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (7.5 mmol-L^-1), H₂O₂ (29 mmol.L^-1). Creatinine standard solution (250 μmol.L^-1). = 14:1.

Fig. 14 shows the calibration characteristics of the method for the determination of creatinine in an aqueous medium according to the invention for a creatinine concentration in the range of 0-1000 μmol.L^-1, for reaction times: 200 s, 300 s and 630 s. = 14:1. n = 3.

Fig. 15 shows the relationship of the fluorescence intensity of the creatinine-DNBA reaction product over time for albumin concentration in the range of 0-40 g-L^-1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (7.5 mmol-L^-1), H₂O₂ (29 mmol.L^-1). Creatinine standard solution (250 μmol. L^-1

Fig. 16 shows the calibration characteristics of the method for determining creatinine according to the invention in an aqueous medium for a creatinine concentration in the range of 0-300 μmol.L^-1, for pure solutions and with the addition of albumin at a concentration of 40 g-L^-1, for the measurement time: 110 s and 400 s. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (7.5 mmol.L^-1), H₂O₂ (29 mmol.L^-1). Creatinine standard solution (250 μmol.L^-1). = 14:1. n = 3.

Fig. 17 shows a comparison of the fluorescence intensity of the creatinine-DNBA reaction product over time for various reagent to sample volume ratios: 1:1, 14:1 and 299:1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (12.5 mmol.L^-1), H₂O₂ (29 mmol.L^-1). V_BTD/V_H2O = 0.8:1. Creatinine standard solution (250 μmol.L^-1). n = 3.

Fig. 18 shows a comparison of the fluorescence intensity of the creatinine-DNBA reaction product over time in the presence of albumin at a concentration of 40 g-L^-1 for various reagent to sample volume ratios: 1:1, 14:1 and 299:1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (12.5 mmol.L^-1), H₂O₂ (29 mmol.L^-1). V_BTD/V_H2O = 0.8:1. Creatinine standard solution (250 μmol.L^-1). V_REAGENT/V_SAMPLE = 14:1. n = 3.

Fig. 19 shows the interferences of the fluorimetric method of creatinine determination according to the invention using V_REAGENT/V_SAMPLE = 14:1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (12.5 mmol.L^-1), H₂O₂ (29 mmol.L^-1). V_BTD/VH₂O = 0.8:1. Creatinine standard solution (250 μmol.L^-1). n = 3.

Fig. 20 shows the interferences of the fluorimetric method of creatinine determination according to the invention when V_REAGENT/V_SAMPLE = 1:1. λ_ex = 405 nm, λ_em = 480 nm. Reagent: DNBA (25 mmol.L^-1), H₂O₂ (44 mmol.L^-1). V_BTD/V_H2O = 0.8:1. Creatinine standard solution (100 μmol.L^-1). n = 3.

Fig. 21 shows a comparison of the selectivity of the creatinine determination method according to the invention with the photometric method using DNBA and with the Jaffe methods.

Fig. 22 shows the results of the determination of creatinine in synthetic serum employing the method according to the invention for different sample dilutions (2x, 5x, 10x) and incubation time (200-630 s). A - HN serum, B - HP serum, C - 1:1 HN/HP mixture, D - 3:1 HN/HP mixture. The declared range of concentrations is marked with dashed lines.

Fig. 23 shows the degree of correlation between the results obtained employing the creatinine determination method according to the invention and the results obtained in the Central Clinical Laboratory using the enzymatic method. 95% confidence interval, n = 3.

Fig. 24 is a Bland-Altman plot showing the agreement between the results obtained when employing the method of the invention and the results obtained when using the enzymatic method.

Detail description of the invention

Despite the long history of determinations of creatinine in clinical biological samples, it is still a significant problem to find a reliable, cheap and convenient analytical method for this purpose, which would be characterized by greater reliability than the routine Jaffe method, as well as lower price and lower complexity than the routinely used enzymatic methods. This is evidenced, for example, by numerous reviews and research papers published in recent years on the subject, that may be related to the ever-increasing number of people suffering from chronic kidney disease (25% increase in the incidence in 2005-2015) [Lancet 388 (2016) 1545-1602].

The research on the present invention was inspired by the desire to provide a method of high reliability (selective against other components of biological samples), which would be easy, fast and cheap to be prepare. As a result, the new method would be competitive to the Jaffe method, which is highly susceptible to interferences, and to the enzymatic methods, the disadvantageous due to the need of using expensive preparations with limited durability and to the need of using long incubation times.

Research has focused on the development of a fluorimetric method for determining creatinine in serum samples, although the analysis of creatinine concentration in urine and dialysate is also very important, mainly because creatinine is used as an indicator of urine dilution and is proportional to the patient's muscle mass. In addition, urine and dialysate have a much poorer matrix than blood serum, they should not contain proteins and bilirubin, the level of creatinine in - 11 - the urine is 2 orders of magnitude higher than in the blood serum and the level of creatinine in the dialysate is similar to the level of creatinine in the blood serum.

However, the differences in the characteristics of the above-mentioned biological samples do not affect the applicability of the creatinine determination method according to the invention, which may be successfully applied to all those types of samples, just taking into account the necessary dilutions to ensure optimal creatinine content in the analyzed samples.

Literature reports indicated that it is possible to determine creatinine fluorimetrically on the basis of the creatinine reaction with 3,5-dinitrobenzoic acid [K. G. Blass, Clin. Biochem. 28 (1995) 107-111], however, so far no one has reproduced the results. In the course of the research related to the present invention, it was proven that the previously described method does not work even under the proposed conditions and that it is not possible to obtain a fluorimetric signal even when larger amounts of the analyte are used (Fig. 2).

The role of hydrogen peroxide

In the course of the current research, however, a significant analytical potential of the fluorimetric method of creatinine determination based on its reaction with ions 3,5-dinitrobenzoate ions has been confirmed (the ions being introduced into the reaction system as a reagent comprising

3.5-dinitrobenzoic acid, a salt or an ester thereof).

The observation that allowed for further experiments was the finding that the presence of hydrogen peroxide in the reaction mixture leads to the formation of a fluorescent product in the creatinine reaction with 3,5-dinitrobenzoic acid dissolved in 1,4-butanediol in a strongly alkaline medium. The emission spectrum of the fluorophore after excitation by radiation with a wavelength of 405 nm (maximum of the absorption spectrum) is shown in Fig. 1. The maximum emission of the fluorophore occurs at a wavelength of 480 nm.

The key to the effectiveness of the creatinine determination method was the addition of hydrogen peroxide to the reaction environment, conditioning and enabling the occurrence of the fluorescence phenomenon in the presence of the product of creatinine reaction with

3.5-dinitrobenzoate ions. The use of H₂O₂ in the fluorescence determination of creatinine has not been previously known in the literature.

Although the mechanism of hydrogen peroxide action in the creatinine reaction with

3,5-dinitrobenzoate ions in an alkaline environment is still unknown, a reproducible and reliable effect is achieved. Currently, it has been excluded that hydrogen peroxide oxidizes the solvent used to prepare the acid solution, because while it is possible to oxidize alcohols by peroxide, the reaction requires the presence of a catalyst in the form of sodium tungstate and tetraalkyl-ammonium hydrogen sulfate, a significantly increased concentration of hydrogen peroxide and the elevated temperature [N. Ryoji et al., Chem. Commun. 16 (2003) 1977-1986]. Moreover, the fluorescent reaction product is formed not only when hydrogen peroxide is previously added to the component solution containing 3,5-dinitrobenzoic acid and an organic solvent (e.g. 1,4-butanediol), but also when it is mixed with the component solution containing the base (e.g. LiOH, NaOH, KOH), and also when it is added separately just before the reaction. It was also confirmed that the replacement of the H₂O₂ addition with the enrichment of the reaction reagent with the solvent oxidation product (e.g. succinic acid, which is the 1,4-butanediol oxidation product) does not allow for fluorescence in the tested system. Without wishing to limit the scope of possible explanations, it is necessary to mention the observation made, which may contribute to explaining the mechanism of the taking place reaction. For all tested NaOH concentrations, after approx. 20-30 seconds of incubation, the phase of intense signal increase begins, followed by a decrease in the fluorescence intensity to a value close to the signal corresponding to the blank sample, and after approx. 3600 s the fluorescence disappears (Fig. 7). This suggests that the fluorescent compound may be an intermediate product of the creatinine reaction with 3,5-dinitrobenzoate anions, which intermediate product is transformed after some time into a non-fluorescent final product.

Assumptions on usability of the method

In the first phase, the conditions of the reaction between creatinine and 3,5-dinitrobenzoic ions, leading to the formation of the previously described product (complex/adduct) absorbing and/or emitting electromagnetic radiation, were investigated and optimized. Then, the calibration characteristics of the developed method and its analytical parameters, such as the limits of detection and quantification, linear range and precision, were determined. The selectivity of the method according to the invention was also tested and compared with the selectivity of the routinely used Jaffe method. The working examples demonstrate the use of the developed protocols for the determination of creatinine in serum, urine and dialysate samples.

In the course of the work, the main problem turned out to be a significant reduction of the analytical signal caused by the presence of interferents, especially proteins, in biological samples. In such cases, the most common remedy is the addition of denaturing agents to denature proteins, or the addition of a constant amount of protein to the calibrators. Unfortunately, in the case of the method according to the invention, no effective denaturing agent was found, which does not exclude the possibility of developing such an agent in future. In turn, the possible addition of protein to the calibration solutions would significantly deteriorate the sensitivity of the reaction, because the presence of even small amounts of albumin (20 g-L^-1) causes a decrease in the fluorescence of the reaction according to the invention by as much as 90%. This effect can be minimized by significant (e.g. 50-fold) dilution of biological samples, which is, however, inconvenient and practically excludes the possibility of carrying out measurements in accordance with the concept of point of care testing, i.e. conducting analytical tests directly at the place of patient care - at the bedside in hospitals, in ambulances or in GP practices by staff not being trained in clinical analytics.

Optimization of the fluorimetric method of creatinine determination in biological samples

The optimization of the method according to the invention consisted in determining the optimal composition of a fluorimetric reagent, containing all the necessary components for the creatinine reaction with the 3,5-dinitrobenzoate anion.

During the optimization experiments, the following were determined:

- optimal concentration range of 3,5-dinitrobenzoate ions,

- optimal concentration range of the base maintaining the pH of the reaction mixture above 12,

- optimal range of hydrogen peroxide concentration,

- optimal volume ratio of organic solvent to water,

- optimal volume ratio of the fluorimetric reagent to a biological sample. During optimization experiments, a fluorimetric reagent was produced using mainly 3,5- dinitrobenzoic acid, 1,4-butanediol, water, hydrogen peroxide and sodium hydroxide, due to their easy availability and low cost. Typically, a component solution containing 3,5-dinitrobenzoic acid,

1.4-butanediol, water and hydrogen peroxide at appropriate concentrations was formed and mixed with the component solution containing NaOH just prior to the experiment.

However, the established procedure does not exclude replacing of the above components with their chemical equivalents, which will play an identical function in the fluorescence process of the creatinine-DNBA reaction product. The task of the 3,5-dinitrobenzoic acid compound is to form a complex/adduct in the course of its reaction with creatinine. The purpose of the organic solvent is to facilitate the dissolution of the 3,5-dinitrobenzoic acid compound since, for example,

3.5-dinitrobenzoic acid is poorly soluble in water. However, this does not exclude carrying out measurements in a pure-water solution, as long as it ensured to be alkaline, which enables the formation of 3,5-dinitrobenzoate anions. The role of the base is to provide an alkaline environment that stabilizes the 3,5-dinitrobenzoate anions and enables the fluorescence process to take place, and in the case of measurements in an aqueous medium, also to facilitate the dissolution of the

3.5-dinitrobenzoate compound. The role of hydrogen peroxide is to enable the fluorescence process to take place.

According to the invention, it is possible to use 3,5-dinitrobenzoic acid, 3,5-dinitrobenzoate salt (e.g. sodium salt) or 3,5-dinirobenzoate ester (e.g. methyl 3,5-dinitrobenzoate) as the source of

3,5-dinitrobenzoate anions. Any organic solvent that dissolves the 3,5-dinitrobenzoate compounds and is highly miscible with water may be used. For example, monohydric alcohol (methanol, ethanol, propanol or butanol), polyhydric alcohol (1,4-butanediol, 1,2-propanediol or ethylene glycol) or mixtures thereof can be used. Any aqueous or aqueous-organic solution of a base in concentration above 0.05 mol.L^-1 can be used, as long as the base (organic or inorganic) does not significantly interfere with the fluorescence of the product of creatinine reaction with 3,5-dinitrobenzoate, such as for example alkali metal hydroxide (LiOH, NaOH, KOH, RbOH, CsOH), ammonium hydroxide, organic bases (tetramethylammonium hydroxide, tetraethylammonium hydroxide, tetrabutylammonium hydroxide) or mixtures thereof may be used. It is possible to use an aqueous or a water-organic hydrogen peroxide solution.

According to the invention, the fluorimetric reagent is prepared from suitable components which are mixed in any order and combination prior to addition of a clinically significant biological sample. The fluorescent reagent is stable at room temperature for more than 100 hours.

Optimization of the composition of the fluorimetric reagent containing organic solvent

Unless otherwise stated, in all fluorimetric measurements the operating voltage of the photomultiplier was 700 V, while the width of the slots for both the excitation beam and the emitted beam was 2.5 nm. A beam excitation with a wavelength of λ_ex = 405 nm (maximum of the absorption spectrum of the creatinine-DNBA reaction product, Fig. 1) was used, and the fluorescence intensity was recorded for the wavelength λ_em = 480 nm (the maximum emission spectrum of the creatinine- DNBA reaction product, Fig. 1). In kinetic measurements, the signal was recorded every second. All optimization runs are standardized. Scinco FluoroMate FS-2 spectrofluorimeter was used.

In order to select the optimal solvent for 3,5-dinitrobenzoate compounds, which are the main component of the fluorescent reagent, a series of measurements was performed. The criteria that must be met by an optimal solvent are: first of all miscibility with water, low volatility and low toxicity. Initially, monohydroxy alcohols (methanol, ethanol, propanol), polyhydroxy alcohols (ethylene glycol, 1,2-propanediol, 1,4-butanediol) and aqueous alkaline solutions were selected. A series of fluorimetric reagent solutions were prepared using pre-selected solvents in a ratio of 0.8:1 with water, containing DNBA (12.5 mmol.L^-1), NaOH (1 mol.L^-1), H₂O₂ (29 mmol.L^-1). After mixing the reagent with the standard solution of creatinine (250 μmol-L^-1) in a volume ratio of 14:1, the variability of the fluorescence intensity (λ_em = 480 nm) was recorded after excitation by irradiation of the wavelength λ_ex = 405 nm. Measurable fluorescence was recorded in each of the tested alcohols. Among the solvents used, 1,4-butanediol allows for the fastest reaction between DNBA and creatinine (maximum intensity approx. 4200 counts, after an incubation time of approx. 450 s). Methanol also seems to be a very promising solvent (4800 counts/520 s), but due to its volatility, there were large differences between the obtained results, and its toxicity could exclude it from applicability. Of all the solvents tested 1,2-propanediol could be an alternative for 1,4-butanediol (4000 counts/450 s) because it is non-toxic, readily available and inexpensive. The results are shown in Fig. 3.

In order to select the optimal concentration of H₂O₂ in the fluorimetric reagent, a series of reagent solutions containing DNBA (13.5 mmol.L^-1), NaOH (1 mol.L^-1) 1.4-butanediol and water in a volume ratio of 0.8:1, and H₂O₂ in various concentrations ranging from 0-145 mmol.L^-1 were prepared. After mixing the reagent with the creatinine standard solution (250 μmol.L^-1) in a 14:1 volume ratio, the dependence of the fluorescence intensity on time was investigated (λ_ex = 405 nm,λ_em = 480 nm). The optimal kinetics (5000 counts/480 s) was observed for an H₂O₂ concentration of 29 mmol.L^-1. A slightly higher intensity of fluorescence was observed for the concentration of H₂O₂

14.5 mmol.L^-1, but a longer incubation (6000 counts/700 s) was required, which would be burdensome with the routine use of the method. The results are shown in Fig. 4.

In order to select the optimal volume ratio of 1,4-butanediol to the component of the H₂O₂ solution in water (initial concentration C° H₂O₂ = 580 mmol.L^-1), a series of reagent solutions containing DNBA (13.5 mmol.L^-1), NaOH ( 1 mol.L^-1) were prepared. The range of changes in the concentration of H₂O₂ in the fluorimetric reagent was: 0-58 mmol.L^-1. The range of changes in the volume ratio 1,4-butanediol to water ranged from 1:1 to 0.67:1. After mixing the reagent with the standard creatinine solution (250 μmol.L^-1) in the volume ratio of 14:1, the dependence of fluorescence intensity on time was investigated (λ_ex = 405 nm, λ_em = 480 nm). The most favorable volume ratio of BTD to H₂O₂ aqueous solution was found to be the ratio 9:1 (5800 counts/480 s). The results are shown in Fig. 5.

In order to select the optimal concentration of DNBA in the fluorimetric reagent, a series of reagent solutions containing NaOH (1 mol.L^-1), H₂O₂ (29 mmol.L^-1), 1,4-butanediol and water in the volume ratio of 0.8:1, and DNBA at various concentrations ranging from zero to saturation were prepared. After mixing the reagent with the creatinine standard solution (250 μmol-L^-1) in a volume ratio of 14:1, the dependence of the fluorescence intensity on time was investigated (λ_ex = 405 nm, λ_em = 480 nm). The optimal kinetics (4500 counts/450 s) was observed for DNBA concentration of

12.5 mmol.L^-1. The results are shown in Fig. 6.

In order to select the optimal concentration of NaOH in the fluorimetric reagent ensuring maximum sensitivity of the method, a series of reagent solutions containing DNBA (12.5 mmol.L^-1), H₂O₂ (29 mmol.L^-1), 1,4-butanediol and water in the volume ratio of 0.8:1, and NaOH at various concentrations ranging from 0-2 mol.L^-1 were prepared. After mixing the reagent with the standard creatinine solution (250 pmol.L ^-1) in the volume ratio of 14:1, the dependence of the fluorescence intensity on the time was investigated (λ_ex = 405 nm, λ_em = 480 nm). The change in NaOH concentration within the range of 0.75-1 mol.L^-1 does not significantly affect the kinetic course of the reaction. 2 mol.L^-1 was selected as the optimal concentration as it provides a slightly faster reaction between creatinine and DNBA (5000 counts/450 s). Interestingly, after an hour, the fluorescence intensity for all tested concentrations is equal to the fluorescence intensity recorded at the beginning of the chemical reaction, which means that the fluorescent product is likely to completely degrade during this time. The results are shown in Fig. 7.

In result of the optimization experiments, the following concentrations of the components in the fluorimetric reagent were selected: DNBA (12.5 mmol.L^-1), NaOH (1 mol.L^-1), H₂O₂ (29 mmol.L^-1), 1,4-butanediol and water in a volume ratio of 0.8:1.

After optimization of the fluorimetric reagent composition, the calibration characteristics and validation parameters of the method according to the invention were determined. For this purpose, a reagent with the optimal composition indicated above was prepared, as well as a series of creatinine standard solutions with concentrations ranging from 1-1000 μmol.L^-1. After mixing the reagent with the creatinine standard solution in a volume ratio of 14:1, the fluorescence intensity of the creatinine-DNBA reaction product was measured after three different incubation times: 200 s, 300 s, 630 s (λ_ex = 405 nm, λ_em = 480 nm). The calibration dependencies are shown in Fig. 8, and the basic validation parameters are given in Table 2.

Table 2. Basic analytical parameters of the fluorimetric method of creatinine determination according to the invention for the reagent containing 12.5 mmol.L^-1 DNBA, 1 mol.L^-1 NaOH, 29 mmol.L^-1 H O , 1,4-butanediol and water in a 0.8:1 volume ratio. 14:1 volume ratio of reagent to sample. 200 μL sample volume. DL - limit of creatinine detection, QL - limit of creatinine quantification. The limits of detection and quantification of creatinine were calculated as the concentration corresponding to the mean of the measurement for the blank plus 3 or 10 standard deviations, resp.; n = 10.

The developed creatinine protocol shows linearity within the range 2.6-750 μmol-L^-1. The sensitivity of the method increases with the incubation time in the first phase (average 1-800 s), and then decreases due to the varying fluorescence intensity over time (Fig. 7), with an intense increase in fluorescence intensity following a 20 second incubation. This means that the optimal time for carrying out the measurement is on average in the range of up to about 800 s, but it is possible to conduct research in the entire range of fluorescence time (20-3600 s). The method according to the invention can be used to test biological samples because the physiological range of creatinine in these fluids is within or is greater than the linear range of the method, which allows for possible dilution of the fluids (blood serum 45-110 μmol.L^-1, urine 4-18 mmol.L^-1, dialysate 20-1000 μmol.L^-1). The influence of proteins on possibility of creatinine determination in water-organic environment

In order to check protein interference in the method of creatinine determination according to the invention, the dependence of the fluorescence intensity on the time (λ_ex = 405 nm, λ_em = 480 nm) was recorded for the creatinine standard solution of the concentration of 250 μmol.L^-1 and for the same standard containing the addition of albumin (10-40 g-L^-1). The results of this experiment are shown in Fig. 9. It was observed that the presence of albumin starts to influence the fluorimetric signal after a certain time and not from the beginning of the reaction. Initially, i.e. up to 200 seconds of the reaction time, the fluorescence intensity is independent of the albumin concentration in the sample. This result suggests that it is possible to determine creatinine in the blood serum and without diluting the sample. It is worth noting that lower concentrations of albumin (10-20 g-L^-1) begin to reduce the signal only after about 300 seconds of the reaction between creatinine and DNBA. These are the concentrations of proteins lower than in the blood serum (approx. 40 g-L^-1), but in the case of dilution it is possible to extend the measurement time, which is advantageous due to the method sensitivity increasing with time (0-800 s).

In order to check whether the degree of albumin interference depends on the creatinine concentration, a series of creatinine standard solutions with the addition of albumin at a concentration of 40 g-L ¹ were prepared. The dependences of the fluorescence intensity (λ_ex = 405 nm, λ_em = 480 nm) were recorded for the incubation time of 200 s. The obtained results are shown in Fig. 10. It was observed that the protein at the physiological concentration is not a significant interferent of the method according to the invention at creatinine concentrations below 200 pmol L^-1, because the calibration curve recorded with and without protein overlaps in this range. This means that irrespective of the creatinine concentration, it is possible to discriminate between the influence of proteins on the determination by measuring the fluorescence intensity after a maximum of 200 seconds for undiluted serum and for diluted serum after at least 300 seconds.

Optimization of the composition of the fluorimetric reagent based on an aqueous solvent

The optimization of the reaction conditions began with the selection of the optimal concentration of H₂O₂ in a fluorimetric reagent in which DNBA was dissolved in an aqueous NaOH solution. A series of reagent solutions containing DNBA (12.5 mmol.L^-1), NaOH (1 rnol-L^-1) and H₂O₂ in various concentrations ranging from 0-145 mmol.L^-1 were prepared. After mixing the reagent with the standard creatinine solution (250 μmol.L^-1) in the volume ratio of 14:1, the dependence of the fluorescence intensity on the time was investigated (λ_ex = 405 nm, λ_em = 480 nm). Concentration of 29 mmol.L^-1 was selected as the optimal concentration of H₂O₂, analogous to the experiment with 1,4-butanediol. The results are shown in Fig. 11.

In order to optimize the concentration of DNBA in the fluorimetric reagent, a series of reagent solutions containing H₂O₂ (29 mmol.L^-1) and DNBA dissolved in NaOH solution in the DNBA/NaOH molar ratio equal to 2:3 was prepared, with the DNBA concentration fluctuating in the range of 0-50 mmol.L^-1. After mixing the reagent with the creatinine standard solution (250 μmol.L^-1) in a volume ratio of 14:1, the dependence of the fluorescence intensity on time was investigated (λ_ex = 405 nm, λ_em = 480 nm). The highest fluorescence intensity was recorded for a DNBA concentration of 7.5 mmol.L^-1. The results are shown in Fig. 12.

The optimal concentration of NaOH in the fluorimetric reagent was determined after the preparation of a series of reagent solutions containing DNBA (7.5 mmol.L^-1), H₂O₂ (29 mmol.L^-1) and NaOH in various concentrations ranging from 0-2 mol.L^-1. After mixing the reagent with the standard creatinine solution (250 μmol.L^-1) in the volume ratio of 14:1, the dynamics of the a nalytical signal increase (λ_ex = 405 nm, λ_em = 480 nm) was tested. It was observed that the use of NaOH in a concentration in the range of 0.75-1.5 mol.L^-1 gives similar results, but the concentration of 1 mol.L^-1 gives the greatest sensitivity. The results are shown in Fig. 13.

In effect of the optimization experiments, the following concentrations of the components in the fluorimetric reagent not containing organic solvents were selected: DNBA (7.5 mmol.L^-1), NaOH (1 mol.L^-1), H₂O₂ (29 mmol.L^-1).

Calibration characteristics of the method were determined in accordance with the developed protocol. For this purpose, creatinine standard solutions with the concentration range of 1-1000 μmol.L^-1 were prepared and the fluorescence intensity was recorded after three reaction times: 200 s, 300 s, 630 s. The calibration curves for the fluorimetric creatinine determination method are shown in Fig. 14 (λ_ex = 405 nm, λ_em = 480 nm). The analytical parameters are presented in Table 3.

It was observed that elimination of the organic solvent from the reaction medium causes a great loss of sensitivity of the method according to the invention and an increase in the limits of quantification and detection of creatinine. Wiling to determine serum creatinine without the use of an organic solvent, even a fivefold dilution may be at risk of obtaining a solution with a creatinine concentration lower than its limit of quantification. A possible solution to this problem may be to increase the width of the slots for the excitation and the emitted beams, but such an approach may reduce the selectivity of the method.

Table 3. Basic analytical parameters of the fluorimetric creatinine determination method according to the invention for a reagent containing 7.5 mmol.L^-1 DNBA, 1 mol.L^-1 NaOH, 29 mmol.L^-1 H₂O₂. 14:1 volume ratio of reagent to sample. 200 μL sample volume. DL - creatinine detection limit, QL - limit of quantification of creatinine. The limits of detection and quantification of creatinine were calculated as the concentration corresponding to the mean measurement for the blank plus 3 or 10 standard deviations, resp.; n = 10.

The influence of proteins on the possibility of creatinine determination in water environment

In order to investigate the influence of proteins on the kinetics of fluorescence (λ_ex = 405 nm, λ_em = 480 nm), a creatinine standard solution (250 μmol.L^-1) was prepared with different albumin content (10-40 g-L^-1) and the dependence of fluorescence intensity on time was recorded after mixing it with the reagent of optimal composition presented above. The results are shown in Fig. 15. It was observed that the influence of proteins is significant after a very short incubation time (approx. 110 s), which makes difficult the reliable determination of serum creatinine carried out according to the method of the invention using an aqueous reagent.

To investigate whether the observed relationship is present for other creatinine concentrations, a calibration curve was constructed without protein and in the presence of 40 g-L^-1 albumin in the standard. The time when the presence of proteins starts to lower the signal is short, and is approx. 100 seconds. For time in which the sensitivity of the method would be the highest due to the potentially high intensity of fluorescence (approx. 400 s), interferences from proteins prevent a reliable determination of creatinine. The results are shown in Fig. 16.

The volume ratio of the reagent to the biological sample

Optimization of the volume ratio of the reagent to a sample is needed due to the two opposing trends: increasing the sample volume increases the amount of analyte and lowering the limit of detection, and in turn reducing the sample volume, the degree of interference of other components of the sample decreases. Control measurements were carried out by mixing the water- organic reagent with the sample in volume ratios of 1:1, 14:1 and 299:1, and the concentrations of components in the obtained mixture were constant and amounted to 12.5 mmol.L^-1 DNBA, 1 mol.L^-1 NaOH, 29 mmol.L^-1 H₂O₂, and the volume ratio of 1,4-butanediol and water was 0.8:1. A series of creatinine standard solutions (250 μmol.L^-1) containing a number of potential interferents (glucose, uric acid, bilirubin, albumin, phosphates, urea) were prepared. After mixing the reagent with standard solutions in appropriate volume ratios, the dependence of fluorescence intensity on time was examined (λ_ex = 405 nm, λ_em = 480 nm) and the comparative results are presented in Figs. 17 and 18. In the presence of interferents, the highest fluorescence intensity was observed for the systems in ratio of 14:1, and the 1:1 and 299:1 systems showed lower fluorescence intensity.

The interference of creatinine determination due to the presence of proteins (e.g. albumin) decreased with the increase in the ratio of the fluorescent reagent volume to the sample volume, because the amount of interferents in the tested mixture also decreased. For the 1:1 samples, the relative error due to the presence of proteins was as high as 100% (Fig. 19), and for the 14:1 samples it dropped to as little as 25% (Fig. 20). In turn, the detection limit increased with an increase in the ratio. Significant dilution of the sample at a ratio of 299:1 during the measurement increased the limit of detection for creatinine to a value of about 30 μmol.L^-1, which still allowed the assay to be performed, but indicated that further increasing the volume ratio would practically exclude the usefulness of such a protocol. On the other hand, the use of the = 1:1 protocol allowed to reduce the limit of creatinine detection significantly below 1 μmol.L^-1, (Table 4), but caused a significant (90%) extinction of the fluorescence of the product of creatinine reaction with anions of 3,5-dinitrobenzoic acid caused by the interfering proteins present in significant concentrations in the sample.

Table 4. Basic analytical parameters of the fluorimetric method for determination of creatinine according to the invention for a reagent containing 25 mmol-L^-1 DNBA, 0.75 mol-L^-1 NaOH, 44 mmol.L^-1 H O , 1,4-butanediol and water in a 0.8:1 volume ratio. 1:1 volume ratio of reagent to sample. Sample volume 1500 pL. DL - limit of creatinine detection, QL - limit of creatinine quantification. The limits of detection and quantification of creatinine were calculated as the concentration corresponding to the mean measurement of the blank plus 3 or 10 standard deviations, resp.; n = 10. Analytical measurements of the mixture of fluorimetric reagent and a sample in a volume ratio of 14:1 were considered to be the optimal protocol. When using such a protocol, the method of the invention has low detection and quantification limits, as well as high selectivity, because none of the potential interferents significantly influenced the recorded fluorimetric signal - the error caused by the presence of most interferents is not greater than ±7% for incubation times below 300 s.

Comparison of the method according to the invention with the Jaffe method

The selectivity of the inventive fluorimetric creatinine determination method was compared to the Jaffe single point and two-point methods and to the photometric method based on o the creatinine reaction with DNBA by examining creatinine standard solutions containing admixtures of significant interferents present in biological samples (Fig. 21). As can be seen, the method according to the invention has the greatest selectivity for creatinine. Importantly, the error caused by the presence of bilirubin in the sample has been almost completely eliminated. In case of the Jaffe method, to get similar result it is necessary to make a two-point measurement, which is not preferred in analytical methods. Moreover, compared to other methods, the error caused by the presence of proteins is significantly reduced. In this form, the fluorimetric method for determining creatinine can be successfully applied to the determination of creatinine in blood serum, but also in urine and dialysate, where the problem of protein interference generally does not occur.

Use of the method according to the invention in the measurement of synthetic sera

In order to verify the suitability of the method according to the invention for clinical trials, measurements were carried out on synthetic sera with normal (Cormay Serum HN) and pathological (Cormay Serum HP) content of creatinine and other components, as well as in their mixtures in dilutions ranging from 1 to 10 (Table 5).

The creatinine content of the samples was determined by the method of the invention using a fluorimetric reagent of an optimized composition: DNBA (12.5 mmol.L^-1), NaOH (1 mol.L^-1), H₂O₂ (29 mmol.L^-1), V_BTD/V_H2O = 0.8:1, V_REAGENT/V_SAMPLE = 14:1. The cuvette was closed with a stopper and its contents was mixed. The results are shown in Fig. 22 and Table 5.

It has been observed that dilution of the serum sample prior to measurement is necessary to obtain reliable results. Creatinine concentrations determined in the undiluted serum sample significantly deviate from the nominal concentrations. The measurement time should depend on the degree of sample dilution - the more diluted the sample, the longer the incubation time should be used, for example: 200 s for a 2x dilution, 300 s for 5x, 630 sec for 10x. This trend is consistent with the results described above (Figs. 9, 10, 15, 16). For high sample dilution, the influence of proteins on the measurement is eliminated, but a long incubation time is advantageous due to the increased sensitivity of the method. On the other hand, for smaller protein dilutions, proteins reduce the analytical signal and therefore it is necessary to shorten the incubation time. Table 5. The content of creatinine and protein in the Cormay control sera and the results of determinations by the method according to the invention using the fluorimetric reagent: DNBA (12.5 mmol.L^-1), NaOH (1 mol-L^-1), H O (29 mmol.L^-1), 1,4-butanediol and water in a volume ratio of 0.8:1. V_REAGENT/V_SAMPLE = 14:1. Measurements were carried out for various dilutions of sera, for incubation times of 200 s, 300 s, 630 s. Results within the concentration range declared by the manufacturer are marked in bold.

Use of the method according to the invention for the measurements of blood sera

An optimized protocol was used for the analysis of biological samples. Serum samples were selected for testing because they usually have a greater number of interferents in comparison with urine and dialysate samples which are usually easier to analyze. Samples were obtained from patients of the Independent Public Central Clinical Hospital. During the measurement carried out according to the method of invention, each one of the samples was diluted five times, and the reaction time was chosen to be 300 seconds. Detailed protocol for creatinine determination is provided in the working example. Comparative results were obtained using the enzymatic method at the Central Clinical Laboratory of the Medical University of Warsaw [Cobas, Creatinine plus ver.2, (2009)], and using the Jaffe protocols for one-point and two-point measurement modes.

A correlation was observed between the results obtained by the method according to the invention and the results obtained at the Central Clinical Laboratory using the enzymatic method. The comparison of the results with the determined 95% confidence interval is shown in Fig. 23. The linear regression equation of the obtained points is y = (0.94 ± 0.03) x + (3.66 + 3.22) with the Prearson's coefficient r being 0.996. This result indicates a correlation between the two data sets. Moreover, the agreement between the results obtained by the fluorimetric method and the enzymatic method is shown in the Bland-Altman plot (Fig. 24), which is a graphic illustration of the agreement between the two measurement methods [D. Giavarina, Biochem. Medica. 25 (2015) 141-151]. All the points of the plot are within the agreement interval, i.e. inside the region between the standard deviation lines, which means that the enzymatic method and the method of the invention can be used interchangeably for the determination of creatinine in biological samples. Moreover, in order to verify whether the obtained results differ significantly from the results obtained by the enzymatic method, two-tailed Student's t-test was performed for the confidence interval of 95% and 12 degrees of freedom. The determined value of the t_exp parameter is 1.499, while the critical (tabular) value of the t_crit parameter for this type of test is 2.179. This means that the creatinine concentrations determined by the method of the invention do not differ significantly from the creatinine concentrations determined by the enzymatic method, which is considered the most reliable routine method for creatinine detection.

During the analysis of the results obtained by the Jaffe method, two samples were rejected due to the very large standard deviation of the measurement series. The Student's t-test was used again to check the statistical differences in the results, but after the rejection of two samples, the number of degrees of freedom decreased to 10. Comparing the results obtained with the method according to the invention and the two-point Jaffe method, the t_exp parameter was 0.155, which is less than the critical t_crit value for this test of 2.228. It is also worth mentioning that when comparing the results obtained in the Clinical Laboratory by the enzymatic method with the one-point Jaffe method for a measurement time of 120 seconds, the determined value of the t_exp parameter is 2.964, i.e. it is higher than the critical value. This means that the concentrations determined by the one-point method of the invention are in better agreement with the results obtained with the enzymatic method in the Clinical Laboratory than the results obtained by the one-point Jaffe method.

Cost analysis

The method for determining creatinine according to the invention shows exceptional selectivity, accuracy and precision when compared to the known fluorimetric methods. The results obtained with the method of the invention are comparable with standard measurement methods of other types, but in contrast, the method according to the invention is the only one that uses commercially available reagents. This is beneficial because the dangers and risks of their use, their impact on analysts' health, and recommended waste disposal methods are well known.

The comparison of the cost of performing 100 analyzes (the cost of the reagents alone in terms of the total volume of the reagents and the sample, amounting to 3 mL), shows a similar price range of the optimized method according to the invention (approx. PLN 30) and the Jaffe method (approx. PLN 13). It should be noted, however, that 98% of the determination costs in the method according to the invention relates to the purchase cost of 1,4-butanediol, and replacing it with another solvent (e.g. propylene glycol) can significantly reduce the total cost of the reagents below PLN 13, i.e. below the cost level of the Jaffe method. For comparison, a ready-made commercial enzyme kit allowing to perform 100 determinations costs almost € 450 (about PLN 2,000) [https://www.abcam.com/creatinine-assay-kit-ab65340.html, 14/06/2019]. The cost difference between the method according to the invention and the enzyme method is significant.

Conclusions

The fluorimetric method according to the invention allows for a reliable and precise determination of creatinine concentration in clinically significant biological samples. The results obtained by the method according to the invention are consistent with the results obtained in the Clinical Laboratory using a routine enzymatic method. It is a one-point method, requiring relatively short incubation times (200-630 s), which eliminates the inconvenience of enzymatic methods. The determination range of creatinine is in the range of 0.5-1000 μmol.L^-1, for incubation times of 20-3600 s, preferably 3-750 μmol.L^-1 for 300 s. The method according to the invention allows the measurement of creatinine content in blood serum samples, urine or dialysate after appropriate dilution, and the dialysate often does not need to be diluted.

The speed and simplicity of measurements, as well as the use of non-toxic components of the fluorimetric reagent, make it possible to create measuring systems ready for use at any time and place, in accordance with the concept of point of care testing. The unit measurement price is competitive with other routinely used methods of creatinine determination in biological samples.

The invention is described below in the working examples illustrating the implementation of the method according to the invention using the reagent according to the invention, by means of their use for the determination of creatinine in clinically significant biological samples.

Example 1. Fluorimetric determination of creatinine in blood serum: Two component solutions were prepared. Solution 1: aqueous-organic solution of 3,5-dinitrobenzoic acid (25 mmol-L^-1) and hydrogen peroxide (58 mmol-L^-1) in a mixture of 1,4-butanediol and water in a 9:1 volume ratio. Solution 2: NaOH aqueous solution (2 mol-L^-1). Into the fluorimetric cuvette there were successively introduced: 1.4 mL of Solution 1, and then 1.4 mL of Solution 2, thus obtaining the fluorimetric reagent of the following composition: DNBA (12.5 mmol-L^-1), NaOH (1 mol-L^-1), H₂O₂ (29 mmol-L^-1), 1,4-butanediol and water in a 0.8:1 volume ratio. The reaction was initiated by introducing a 0.2 mL of a sample of 5-fold diluted blood serum into a fluorimetric cuvette, resulting in a mixture of 14:1 volume ratio of the reagent and sample. The content of the cuvette was mixed for 30 s, and then the registration of changes in the fluorescence intensity of the creatinine-DNBA reaction product was started. The value recorded after 300 s of incubation (λ_ex = 405 nm, λ_em = 480 nm) was compared with a previously prepared calibration curve to determine the creatinine concentration in the sample, and the reading was compared with the reference data. The obtained result was within the 95% confidence interval of the reference method (Hitachi Roche Cobas 6000) - enzyme protocol.

Example 2. Fluorimetric determination of creatinine in urine. The procedure was as in Example 1. The reaction was initiated by loading into a fluorimetric cuvette a 0.2 mL sample of 50-fold diluted urine to obtain a 14:1 volume ratio of reagent and sample. The obtained result was within the 95% confidence interval of the reference method (Hitachi Roche Cobas 6000) - Jaffe protocol.

Example 3. Fluorimetric determination of creatinine in a dialysate. The procedure was as in Example 1. The reaction was initiated by loading into a fluorimetric cuvette a 0.2 mL sample of 2-fold diluted dialysate to obtain a 14:1 v/v mixture of reagent and sample. The obtained result was within the 95% confidence interval of the reference method (Hitachi Roche Cobas 6000) - Jaffe protocol.

Claims

1. A fluorimetric analytical method for the determination of creatinine in clinically significant biological samples, in which creatinine is reacted with 3,5-dinitrobenzoic acid in a strongly alkaline aqueous-organic medium to form a fluorophore product, characterized in that a clinically significant biological sample is mixed directly with a multi-component fluorimetric reagent containing 3,5-dinitrobenzoate anions, an organic solvent, water, a base maintaining alkalinity of the reagent above pH = 12, and additionally hydrogen peroxide, whereas detection and/or quantification of the obtained product of creatinine reaction with 3,5-dinitrobenzoate anions is carried out using the fluorimetric method, by taking a measurement of radiation having a wavelength of 450-500 nm, preferably 480 nm, emitted under the influence of an excitation beam of radiation of a wavelength of 380-420 nm, preferably 405 nm, at a constant incubation time after the start of the reaction and determining creatinine concentration on the basis of separately prepared calibration curve that links creatinine concentration in the biological sample with the fluorimetric response characteristic for the given wavelength and incubation time.

2. The method according to claim 1, characterized in that as a component containing 3,5-dinitrobenzoate anions, a solution of 3,5-dinitrobenzoic acid, a 3,5-dinitrobenzoate salt, preferably sodium 3,5-dinitrobenzoate or 3,5-dinirobenzoic acid ester, preferably methyl 3,5-dinitrobenzoate is used, the solution comprising an organic solvent, a mixture of organic solvents, water, or a mixture thereof.

3. The method according to claim 2, characterized in that as the organic solvent, a solvent which is highly miscible with water, preferably a monohydric alcohol or a polyhydric alcohol is used.

4. The method according to 3, characterized in that as the monohydric alcohol, methanol, ethanol, propanol or butanol is used and as the polyhydric alcohol, 1,4-butanediol, 1,2-propanediol or ethylene glycol is used, wherein 1,4-butanediol is the most preferable.

5. The method according to claim 1, characterized in that as the base-containing component, a base solution having a concentration greater than 0.05 mol.L^-1, wherein the solution comprises water, an organic solvent or a mixture of organic solvents, or a mixture thereof.

6. The method according to claim 5, characterized in that as the base, a metal hydroxide, ammonium hydroxide or an organic base that does not significantly interfere with the fluorescence of the product of creatinine reaction with a 3,5-dinitrobenzoate anion, preferably an alkali metal hydroxide (LiOH, NaOH, KOH, RbOH, CsOH), ammonium hydroxide, tetramethylammonium hydroxide, tetraethylammonium hydroxide, tetrabutylammonium hydroxide, or mixtures thereof, most preferably LiOH, NaOH or KOH, is used.

7. The method according to claim 1, characterized in that as the component containing hydrogen peroxide, an aqueous or aqueous-organic hydrogen peroxide solution is used.

SUBSTITUTE SHEET

8. The method according to claim 1, characterized in that the fluorimetric reagent is made of components including 3,5-dinitrobenzoic acid, 1,4-butanediol, water, NaOH and hydrogen peroxide, the components being mixed in any order and combination prior to adding the biological sample of clinical significance.

9. The method according to claim 8, characterized in that at first stable component solutions are prepared, preferably a component solution containing 3,5-dinitrobenzoic acid, 1,4-butanediol, water and hydrogen peroxide, and a component solution containing water and NaOH, which component solutions are mixed immediately before adding the biological sample of clinical significance.

10. The method according to claim 1, characterized in that for samples containing creatinine in concentrations lower than or equal to 750 μmol-L^-1, the reagent is used in which:

- the concentration of 3,5-dinitrobenzoate ions ranges from 0.05 mmol.L- 1 up to saturation, preferably being 12.5 mmol.L^-1,

- the base concentration is 0.05-2 mol.L^-1, preferably 1 mol.L^-1,

11. The method according to claim 1, characterized in that samples containing creatinine in concentrations greater than 750 μmol-L^-1 are diluted to a concentration lower than or equal to 750 μmol.L^-1.

12. The method according to claim 1, characterized in that the volume ratio of the fluorimetric reagent to the clinically significant biological sample is from 1:1 to 299:1, preferably 14:1.

13. The method according to claim 1, characterized in that the measurement of the fluorescence intensity is performed in the range of the observed linear dependence of the fluorescence intensity on the creatinine concentration, i.e. after the time of 20-3600 s, preferably 300 s.

14. The method according to claim 1, characterized in that the creatinine determination range is within the range of 0.5-1000 μmol-L^-1 for the incubation time of 20-3600 s, preferably 3-750 μmol-L^-1 for 300 s.

15. The method according to claim 1, characterized in that it is selective for creatinine in the presence of sugars, proteins and bilirubin.

16. The method according to claim 1, characterized in that a clinically significant biological sample is

- a blood serum at a 2-10-fold dilution, preferably at 5-fold dilution;

- a urine at a 10-400-fold dilution, preferably at 50-fold dilution;

- a dialysate at a 1-5-fold dilution, preferably at 2-fold dilution.

17. A multi-component fluorimetric reagent for use in the analytical fluorimetric method for determination of creatinine in clinically significant biological samples, being alkaline and containing 3,5-dinitrobenzoate anions in an aqueous-organic environment, characterized in that it additionally contains hydrogen peroxide, and after direct mixing with a clinically significant biological sample containing creatinine, selectively produces a fluorophore in the reaction between creatinine and a 3,5-dinitrobenzoate anion, which fluorophore under the influence of an excitation beam of radiation of 380-420 nm wavelength, preferably of 405 nm wavelength, emits radiation of 450-500 nm wavelength, preferably of 480 nm wavelength.

18. The reagent according to claim 17, characterized in that

- a concentration of 3,5-dinitrobenzoate ions is from 0.05 mmol.L^-1 up to saturation, preferably 12.5 mmol.L^-1;

- concentration of a base is 0.05-2 mol.L^-1, preferably 1 mol.L^-1;

- concentration of hydrogen peroxide is 1.45-145 mmol.L^-1, preferably 29 mmol-L^-1;

- the mutual ratio of the solvents ranges from completely organic to fully aqueous, and the optimal ratio of organic solvent to water in the aqueous-organic mixture is from 0.8:1.

19. The reagent according to claim 17, characterized in that it comprises 3,5-dinitrobenzoic acid, 1,4-butanediol, water, NaOH and hydrogen peroxide.

20. The reagent according to claim 17, characterized in that after its preparation, it is stable at room temperature for over 100 hours.

21. The reagent according to claim 17, characterized in that it can be used for the selective determination of creatinine at concentrations ranging from 3-750 μmol.L^-1 in the presence of glucose, proteins and bilirubin, for an incubation time of 20-3600 s, preferably 300 s.